A Case of fulminant Clostridioides difficile enterocolitis saved by diverting loop ileostomy and colonic lavage

Abstract

A 70-year-old man had complained of lower abdominal pain during antibiotic treatment for pneumonia and was admitted to the ICU because of hemodynamic instability. Contrast-enhanced CT revealed edematous changes from the ascending colon to the rectum, ascites, and an increased CT value of mesenteric panniculitis. Blood tests showed a severe inflammatory reaction, acute renal failure, and metabolic acidosis, and the patient was in a state of hemodynamic instability requiring continuous　administration of vasopressors. Furthermore, Clostridioides difficile （CD） antigen and toxin were detected. Thus, fulminant CD enteritis was diagnosed. With suspicion of necrosis of the colon, we performed exploratory laparotomy. Operative findings showed no ischemic changes or wall thinning. We decided to preserve the colon and performed diverting loop ileostomy and colonic irrigation. Although total colectomy is the standard treatment for fulminant CD enteritis, we report a case saved by ileostomy and colonic irrigation.